Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
BMC Public Health. 2021 Mar 6;21(1):457. doi: 10.1186/s12889-021-10477-6.
Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran's health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran.
We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons.
About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN.
It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.
未满足的需求是获得医疗服务的一个关键指标。尽管伊朗卫生系统存在未满足需求的具体证据，但最近没有关于这一负面结果的证据。本研究旨在衡量伊朗的主观未满足需求（SUN）、与其相关的因素以及背后的各种原因。
我们使用了 2016 年伊朗医疗服务利用调查中超过 15 岁的 13005 名受访者的数据。SUN 被定义为那些需求没有通过正规医疗服务来满足的公民，同时他们也没有自我用药的历史。SUN 的原因被分为卫生系统的可及性、可得性、责任性和可接受性。多变量逻辑回归用于确定 SUN 的显著预测因素及其相关的主要原因。
约 17%的受访者（N=2217）有门诊服务未满足的需求。近 40%的受访者只选择了可及性，4%选择了可得性，78%选择了责任性，13%选择了可接受性作为他们未满足需求的主要原因。较高的门诊需求是唯一显著增加 SUN、责任性 SUN 和可接受性 SUN 的因素。较低的教育水平与较高的 SUN 和责任性 SUN 相关，而它也可以降低可接受性 SUN。SUN 和责任性 SUN 在较低的经济五分位中更为普遍，而补充保险则与 SUN 和责任性 SUN 的减少相关。基本保险的人较少有责任性 SUN，而就业人员则有 SUN 的风险。虽然中年组有更高的机会经历 SUN，但责任性 SUN 则在老年人中更为普遍，而较高的年龄组则有很大的机会面临可接受性 SUN。
伊朗似乎仍在遭受门诊服务未满足的需求，其中大部分源于其卫生系统的绩效。大部分未满足的健康需求可以通过改善财务和组织政策来解决。需要特别关注那些健康状况较差的人的未满足需求。
